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Five Ways Faulty Health IT Implementation Can Hurt Patient Care

Electronic health records can improve care, but doctors should also be mindful of some health IT obstacles that can be detrimental to patients.

Although studies show health care technology does help patient care, when tech tools lead doctors astray, patients can suffer.

For a March 6 report called "Healthcare IT Tipping Point Report," CDW Healthcare found that 84 percent of caregivers believe health care IT improves patient care. Doctors assume that if they're using electronic health records (EHRs), their practice and patients' health will be better off, said Dr. Wendy Whittington, chief medical officer of Anthelio, a Dallas-based health care IT service vendor.

"A lot of times, it's easy to just assume that we're putting in that EHR so that will take care of problems X, Y and Z, and that's a dangerous assumption when it comes to clinical workflows and patient care," Whittington told eWEEK.

The health care IT industry needs to avoid the "utopian" thinking that just because they're automating or using EHRs, things will be faster. "It doesn't mean we shouldn't put in electronic health records; it doesn't mean we shouldn't automate," she said. "It just means that we need to be really mindful of everything as we do it."

Further reading

Whittington outlined five areas of poor health care IT implementation physicians keep in mind to maximize the health benefits that technology can bring to patient care.

1. Decentralization of Data

One area doctors struggle with is the decentralization of information, in which vital data may be difficult to locate all in the same place in a patient's chart.

"It can slow you down and make it harder to find the information you need," said Whittington. When a physician enters weight in one area of a patient's chart, the info may not show up in another area, she explained.

Often when some records are on paper and some in electronic format, these "hybrid records" can also be an obstacle, Whittington suggested.

2. Unnecessary Tests and Studies

Sometimes when physicians don't understand the data or it's in the wrong format, they may order extra studies that may be medically unnecessary, according to Whittington.

With doctors striving for continuity of care, EHRs can indicate that a patient may have had a test performed, such as a CAT scan, but physicians may not be able to tell from the information in the system that an additional test isn't necessary, said Whittington.

In addition, if the radiology tests don't appear in the EHR to be what the physician ordered, they'll ask for additional tests.

"When you go change the format that physicians are used to seeing things in, you risk them saying, 'No, that's not what I wanted,'" said Whittington.

3. Alarm Fatigue

With EHR systems and messaging systems incorporating multiple alarms, excess notifications can sometimes hide the important messages, such as those about allergies, chronic conditions or drug interactions.

"If I have 37 boxes popping up at me and the only one that mattered was that penicillin one, I may have been disregarding them so rapidly that I missed the important one," said Whittington.

"In the old days, you had that paper chart with a big red sticker [indicating] that you're allergic to penicillin," she said.

Now, in the age of EHRs, a triage nurse may enter the data, and conflicting messages may result, said Whittington.

4. Treatment of the Wrong Patients

Doctors can write on the wrong paper chart, but it may be even easier to type symptoms into a wrong EHR, according to Whittington.

"Now, you can easily flip from patient to patient on an electronic screen, which in some ways is a good thing. It saves time and can be more efficient. But I have seen it happen many times where the next thing you know you somehow got yourself onto another patient's record and you're charting away, and it's not always easily understood that you're on the wrong chart," she said. "Some technology helps with eliminating those problems, but it still exits."

These errors can occur when clinicians aren't familiar with the software, Whittington noted. "When the patient's name is tiny in the right-hand corner, you might lose track of who you're working on," said Whittington.

One application that is helpful in keeping records straight is Microsoft's Amalga data intelligence platform, said Whittington. Amalga is the foundation for several HIEs, including one in Florida's Miami-Dade County and features patient-centric data-aggregation capabilities to spot patterns in population health.

5. Failure to Follow Up

In the CDW report, 68 percent of caregivers believed that IT workflows could help them follow up with patients. Still, doctors could miss follow-up items in EHR software if problems in a practice's workflow exist prior to implementation of the application.

"If the process is broken, the process is broken, and automating it just gives you an automated broken process," said Whittington.

Products such as Phytel's Atmosphere software as a service (SaaS) suite can automate physician communications to bridge gaps in patient care.

Although Whittington does see technology as an answer to improving doctors' workflows and boosting patient care, these challenges must be solved for the tools to really take off in the industry.

"We just have to do it the right way, and the right way isn't always quick and easy," she said.